Iron deficiency is one of the most common micronutrient deficiencies in the world in pregnant women and children and it causes increased risk of perinatal mortality, morbidity and developmental delay. Recent evidence has suggested that iron deficiency may protect against malaria. Thus, the wisdom of universal supplementation in areas of the world where malaria is endemic has come under scrutiny. This application will attempt to identify the mechanism by which the human host's iron status affects the P. falciparum parasite in vitro. Specifically, we will determine if the growth, maturation and invasion rate of P. falciparum parasites is reduced in red blood cells and/or serum from severely iron deficient individuals before and after iron supplementation. The results will contribute to efforts to develop evidence-based iron supplementation policies in malaria-endemic areas. PUBLIC HEALTH RELEVANCE: Iron deficiency affects over 500 million people including many pregnant women and children from areas of the world that are plagued by malaria. It has been suggested that iron deficiency protects against malaria and questions have been raised about the risks associated with the universal iron supplementation programs in countries where malaria is endemic. In the proposed project, we will determine whether the growth and development of the malaria parasite is impacted by the host iron status in vitro. We will use RBC and sera from patients with severe iron deficiency anemia to look at this question in a very systematic way. This study will provide information for or against a possible mechanism by which iron deficiency may affect the malaria parasite. Ultimately, this information will provide additional evidence for the determination of policy on iron supplementation in malaria endemic regions.